While the health effects may not be
as bad as from smoking cigarettes, the concern was, if society was on
the verge of stamping out nicotine addiction, did it need new products
to get people addicted again? “

Reply

End
Smoking NZ trustees are mostly addiction experts, who support the sale
of e-cigarettes as a way to end the sale of tobacco cigarettes.

The
most harmful constituents in tobacco smoke include cancer causing gases
such as butadiene, heart damaging gases such as hydrogen cyanide and
lung damaging gases such as acrolein, not forgetting tar containing
nitrosamines which cause lung cancer. Tobacco cigarettes eventually
kill half of those smoking them.

Nicotine
by itself, although not harmless, is dramatically less harmful than
tobacco. This means that we need an alternative nicotine delivery
system for the percentage of our smoking population that is so addicted
that despite the best efforts of our public health colleagues they
still smoke. Accepting that their eventual decision to quit nicotine as
well as tobacco may be some years off in the real world, they are at
least protected meantime from the severe harms associated with tobacco
smoking by using nicotine products such as e-cigarettes.

Once
efficacy is proven, nicotine e-cigarette effectiveness can be compared
to any side effects reported by hundreds of users over 6 months. A
balanced judgement can then be made as to
whether nicotine ecigs should be sold in NZ
in corner stores.

(Many
would say that ecigs with
nicotine should be sold now with nicotine, from NZ websites. Why
should UK and Chinese websites get all the
business? )

In more
detail.

NZ smokers
will find it difficult enough to quit their tobacco addiction, but
allowing them to switch to nicotine ecigs
would make it much easier.

Getting NZ smokefree
without the help of better substitute products to help smokers
(such as ecigs and denics)
is like reducing smoking with one arm tied behind one’s
back.

Smokers
like ecigs in a way not true of nicotine
patches and gum – ecigs have their
own fan clubs.

Switching
off tobacco to nicotine electronic cigarettes could provide an
important escape product for addicts to inhale while dealing with
their now decreased nicotine addiction in their own good
time.

End
Smoking NZ views in more detail.

1, Prevalence
of purchase and legal position. Currently about 1% of NZ
smokers have bought ecigs without nicotine,
but without nicotine ecigs are not very
successful in weaning smokers gradually off smoking. Ecigs are banned in NZif they contain nicotine. Medsafe says nicotine is a medicine under the Medicines
Act and can only be sold if approved as a medicine. This means nicotine
ecigs cannot be sold.

2. Legislative
position: Nicotine in NZ is a tobacco product if not a medicine; because
nicotine is made from tobacco it is a product of tobacco. This means
tobacco and nonmedicinal nicotine
in NZ comes under the Smokefree Environments Act. But first Medsafe would need to declassify nicotine in ecigs as a medicine, by taking out ecigs from under the Medicines Act. The
current ban preserves the monopoly-provider position of the cigarettes
companies as being the only ones allowed to sell addictive nicotine
vapour outside of a pharmacy.

3. End
Smoking NZ is promoting use of ecigs as one
of its top policies to end smoking of tobacco. Every ecig cartridge smoked is a packet of tobacco
cigarettes not smoked. In USA and UK some 3% of smokers use ecigs. That amounts to billions of tobacco
cigarettes not smoked. Laugesen et al NZ Med J 2010,

4. Risk
of ecigs being a gateway to adult tobacco
addiction.Ecigsdo not by itself
kill people and would be most unlikely to lead to tobacco addiction in
the NZ tobacco policy environment, The
Smokefree Environments Act strictly controls tobacco product
marketing.For example, as from
tomorrow, “discount tobacco” signs at retailers are gone.

5. Nicotine
addiction risk. This develops in nicotine gum users in some 8% of
users, ( http://www.healthnz.co.nz/Addiction_TobNic.htm
) but this is not a reason to take it off the market. Addiction to
nicotine is regarded as a side effect of a valuable treatment for
smokers. E-cigarette forum and vapers club surveys report most members desert after 3 months to 6 months.

6. E-cigs
and adolescents. There
have been no published reports of never smokers developing nicotine
addiction after using nicotine inhalers - either medicinal inhalers or e-cigarettes. If it did
occur, it would not become a youth fashion. Only advertising could make
ecigs cool for young smokers.
Advertising is banned for nicotine e-cigarettes, either as a tobacco
product or as an unlicensed medicine. Ecigs
for adolescentshave not caught on so far. They may do,
but as long as addictive cigarettes are priced higher and
higher, adolescents addicted to nicotine will be unable to afford
more than or two per day.

A drug
free world might mean banning nicotine–perhaps in the 22nd
century. Meantime 1 billion smokers are predicted to die of tobacco
smoking this century.

To
achieve a smokefree NZ by 2025, we first need to get some 600,000
smokers off their probably fatal addiction to tobacco.Smokers like ecigs,
and ecigs can help them to quit their tobacco
smoking addiction.

7. Ecig
addiction is controllable. After 2025, nicotine in ecigs can be easily controlled through taxation in
future and banned if necessary once combustible tobacco cigarettes are
no longer sold.

8. Legalise the antidote to lethal
tobacco cigarettes. For the next 20 years in NZ we believe we need to legalise nicotine in s to get more people off
smoking sooner, ie to maximise
the effects of the tax increases we are asking for.

9.
Quitting sooner means fewer cigarette deaths. Cigarette deaths are due to
smokers quitting too late. People are likely to switch off tobacco
smoking sooner than otherwise, if a nicotine
satisfying is available as an alternative they can gradually or
suddenly switch to. It is all about improved choice of stop smoking
products.

10.
Some controversy. The Cancer Society of NZ has a 2011 position
statement on its website on ecigsatwww.cancernz.org.nz and search.
Since that time new research has been published, and the tide is slowly
turning to be more supportive of electronic cigarettes.

The End
Smoking webisite information is found at www.endsmoking.org.nz under
Smokers options, and envisions a key role for Ecigs
as a clinical and policy lever for phasing out tobacco cigarette sales.

11. Current
policy untenable needs review. However this is an active issue, and
End Smoking NZ believes that ecigs, the best
thing yet to compete with tobacco cigarettes, should not be banned or
regulated in NZ as if they were party pills, in such a way they in
effect cannot be sold, as an unknown product
best banned, which is the case at present, while smoking
tobacco is sold in some 10,000 shops, kills 5000 annually while ecigs have killed no one anywhere to the best of
our knowledge.

12. Light
regulation under the Smokefree Environments Act of ecigs as a non-medical stop smoking aid, seems a
suitable policy which all parties could examine and eventually reach
agreement on.

Petra: “The Ministry of Health is saying
that e-cigarettes are far safer than a normal cigarette, and yet it is not
possible to sell the nicotine that goes with them. What’s the
crux of that situation?”Could it be classified as a tobacco product?

MG:
“Possibly”…“People are using them to switch off
from smoking and - why not? I would like see more smokers to have more
access to things like this - alternatives that are safer. We’ve
got to get people off the cigarette smoke.”

“As the
e-cigarette delivers only nicotine in a mist of propylene glycol,
without the other 4,000 or so other chemicals in tobacco smoke, it is far
safer than smoking.”

“The current
safety data would therefore suggest that the e-cigarette poses few
risks to people, and is safer than continuing to smoke. However, this should
be confirmed with data from long-term outcome studies.

“The
Ministry of Health believes there are research questions still to be
answered around the e-cigarette before the Ministry would support its
introduction and/or promotion in New Zealand. Trials to assess long term cessation
outcome and safety are needed.”

End Smoking NZ congratulates the NZ
Ministry of Health on possibly being the first ministry of health to
concede e-cigarettes are safer than smoking. The Ministry, however,
continues to use Medicines legislation to ban their sale to smokers,
thus obviating the need to regulate ecigs so
smokers could use them. The Ministry could, but is not classifying them
for sale under tobacco products legislation. Not one death has occurred
from e-cigarettes globally to our knowledge.Meantime cigarettes kill one in two
persistent users.

If Ministry
judges that ecigs are indeed “far safer
than smoking”, let smokers decide which risk they wish to take.

Summary

Ministry of
Health says the e-cigarette
“ is far safer than smoking.” But
the Ministry wants more research on safety and efficacy before
introducing nicotine e-cigarettes for sale.

End Smoking NZ says the Ministry of Health should

1)Consider
the real peril of smokers facing a 50% risk of dying from continued
smoking.

2)Consider
what smokers want.Smokers want
a level playing field – they want freedom to
buy nicotine cartridges just as they can buy cigarettes at any of
10.000 shops.

3)As
long as Government permits sale of lethal tobacco cigarettes,
Government has a duty to permit sale of a full range of safer cigarette
substitutes for smokers to buy as of right.

4)E-cigarettes
are not up to medicinal standards of purity. Rather than banning their
sale as medicines they should be sold as cigarette substitutes under
the Smokefree Environments Act. Medicinal purity standards required by the Medicines Act
prevents nicotine e-cigarette cartridges being sold in NZ

5)The
e-cigarette needs regulation, not by banning it under the Medicines
Act, under the Smokefree
Environments Act, as soon as possible.

Avoid
bottled nicotine. Liquid nicotine (e-liquid) is small bottles of up to 30 mL or more, on the internet, or from stores in
the USA, ARE often meant to
last consumers one month; and often unlabelled as to nicotine dose. End
Smoking NZ and Health New Zealand Ltd does not recommend sale or use
of e-liquid unless Nicotine solution sold in child-proofed cartridges
or un-openable disposable e-cigarettes or
atomisers to avoid this risk.

Acute poisoning risk.
For a child, thelethal dose is 10 mg
nicotine. Bottles on sale can contain many times this amount. Even if
the cap of a liquid nicotine bottle is child proofed, risk remains if
someone else leaves it open. For
adults, absorption of a fatal dose of 40-60 mg of
nicotine could rapidly occur byspilling the liquid on one’s skin while using liquid
nicotine to moisten the wick– a risk heightened by distraction,
fatigue, alcohol, drugs. (Wash it off immediately). Wear gloves.

Avoid gravity feed. Old
brand e-cigarettes
should not be tipped up above mouth level, as the e-cigarette liquid
can ooze out and drain nicotine on to the lips.

Avoid child-openable
brands of e-cigarette and refill cartridges. Old long-length
3-piece e-cigarettes might allow young children to unscrew them
giving access to a wick moist with nicotine solution, flavours in the
liquid masking the bitter nicotine taste. Latest 2-piece brands (6 mg
in 0.3 ml liquid), and 1-piece disposables, allow no access.

The mist of the e-cigarette has been
rigorously tested in the laboratory. Of over 60 priority-listed cigarette
smoke toxicants tested, trace levels for some only were detected in
the mist of the Ruyan® e-cigarette. The results are to be submitted
for publication shortly in a peer-reviewed journal. On the
basis of findings to date, inhaling mist from the e-cigarette is
rated some two orders of magnitude (100 times) less dangerous than
smoking tobacco cigarettes. The nicotine dose per puff is comparable
to that of a medicinal nicotine inhaler. E-cigarette nicotine is
apparently not absorbed from the lung, but from the upper airways.

Health New Zealand Ltd sponsored this
research on behalf of Ruyan, manufacturer of the Ruyan V8
e-cigarette, and it was carried it out in Auckland by researchers at
the School of Population Health, University of Auckland. Seehttp://www.healthnz.co.nz/2010%20Bullen%20ECig.pdfThe study was published in Tobacco
Control in April 2010.

TV32008The Ruyan V8 Classic. An LED lights
up the end. The white part is the battery. The nicotine is housed
just upstream of the fingers. Recent models shorter (84 mm), and
lighter.

Legal status (New Zealand)

E-cigarettes
and non-nicotine cartridges can be sold in New Zealand, but not nicotine cartridges.

Nicotine
when sold as a medicine comes under Medicines Act and approval for a
new nicotine medicine is very expensive and takes several years.
Import of e-cigarettes and nicotine cartridges for personal use is
allowed.

About the device

The
e-cigarette nicotine inhaler mimics the smoking experience more
closely than any smokeless product to date and provides nicotine
without causing smokers to cough.

It
looks and acts like a cigarette, gives the pleasure of drawback, with a
nicotine effect within 15 minutes. It is likely to be popular as a
much cleaner and safer alternative to smoking, by eliminating the tar
and the toxicant gases. More frequent puffs deliver more nicotine.
Mouth holding longer may help. Use before coffee, coke, and fruit
juice, not after.

Extended use, misuse of e-cig

The e-cigarette is an inhaler and the
commercial brands do not appear to deliver nicotine deeply into the
lung. Its ability with other drugs is untried. Nicotine by
e-cigarette is probably absorbed from the throat and upper airways
rather than from the lung.

People mixed tobacco with marijuana
for smoking long before e-cigarettes, and smoking is the most
dangerous way to consume cannabis or tobacco.

Devices for heating and vaporizing
cannabis long preceded the e-cigarette. Whether or not e-cigarettes
could be used for that purpose, no smoke will be inhaled.

It is not known whether the e-cigarette
would facilitate absorption of THC, the active ingredient in
cannabis. The e-cigarette vapourises liquid
but does not burn plant material such as marijuana or tobacco. If
cannabis is vaped by e-cigarette, rather than combusted and smoked in
a joint,then no smoke is inhaled. Lung canceris likely after many years
of smoke inhalation, of either tobacco or marijuana smoke.

E-cigarette vaping of cannabis is likely
to cause far lung damage than smoking.

For example, the illegality of cannabis
makes adulteration possible, and prevents legal controls on its
production. Also research safeguards are lacking. The effect of inhaling
and vaporizing THC in the e-cigarette liquid has not been tested and
researched by anyone to our knowledge.

Note: End Smoking NZ trust has no financial interests
in any nicotine, tobacco or pharmaceutical company.

The e-cigarette provides a safer
alternative for smokers. No deaths have yet been reported from
e-cigarette use.